As Down says, the grey areas are what interest him most. Intensive-care guidelines are in place to ingrain the most effective procedures, and thereby reduce the stresses of decision-making in the chaos of a medical crisis. They are not infallible, however. One of Down’s patients is taken off ventilation but then dies from an “airway catastrophe”, even though the guidelines have been followed to the letter. Sometimes doctors might save a patient by deviating from the protocols, but how many more would suffer if they improvised more freely? In many cases there is not a single correct procedure to follow, and failure isn’t necessarily instructive. Good luck and bad luck play a part.

Down and his colleagues have no choice but to honour the wishes of an intelligent young patient who refuses to undergo blood transfusion on religious grounds, even though she is aware that her refusal might prove fatal. By good fortune, she pulls through. Conversely, an alcoholic patient declines rapidly and inexplicably on Down’s watch. Her symptoms suggest an abdominal collapse, but tests don’t find any evidence. Finally it is established that violent vomiting has ruptured the woman’s oesophagus, allowing acidic stomach contents to seep into her chest, lethally. The condition is known as Boerhaave syndrome, and Down berates himself for not arriving at the diagnosis sooner, even though the outcome would have been no different had the rupture been located quickly – the patient could not have survived an operation.

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👏 Well done to UCLH critical care consultant Jim Down on publishing his second book, Life in the Balance.

His new book offers a real glimpse into intensive care medicine, its immense challenges and effects on mental health.

Read more here: https://t.co/B9luDTwutI #OneTeam pic.twitter.com/tGmoRuwhn5

— UCLH (@uclh) February 23, 2023

A Covid-19 recovery grant from Historic England kickstarted a major new lease of life and a successful fundraising drive for further renewal at a village church.

St John’s Ryhall, a Grade 1 listed building in the Diocese of Peterborough, had 28 roof leaks, blocked drains and was damp and cold.

An earlier fundraising drive was cancelled due to Covid-19, while bad winter weather had exacerbated existing damage.

The church was awarded £11,000 from the Heritage Stimulus Fund, part of the Government’s Culture Recovery fund, to help sites hit by Covid-19, to repair its drains, pipes and gutters on its roof.

Rainwater was damaging the walls, and repair work was vital before roof renovation could take place.

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Here’s a painting of St John’s Church Ryhall that I have just completed. I was asked to paint this medieval building to help raise money for the church restoration fund. It will go to the winner of a lottery to help raise money for this very deserving charity. pic.twitter.com/qDa5xVqIyk

— josette carroll (@josettecarroll1) May 14, 2021

Emma Thompson makes for an unlikely rebel. Her Christian faith was nurtured through Anglican choral music and the Book of Common Prayer. She teaches Sunday school and conducts a choir in her church.

“The local level, in my book, is where all the good happens — the love, the looking after your neighbour, the delivery plan for being a Christian,” says Thompson, a former City solicitor and now a company secretary and freelance journalist.

Her passion for local parish churches is fierce to the point that, she says proudly, the two most senior clerics in the Church of England have described her as a “rascally voice”.

Attendance in the Church has fallen by nearly 40 per cent since 1979, according to the British Religion in Numbers online data resources, and by more than 15 per cent alone since 2013.

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My piece in today's @thetimes https://t.co/er0y6xwgox

— abigail frymannrouch (@abigailfrymann) September 30, 2023

Living to 100 today is not unheard of, but is still rare. In America and Britain centenarians make up around 0.03% of the population. Should the latest efforts to prolong life reach their potential, living to see your 100th birthday could become the norm; making it to 120 could become a perfectly reasonable aspiration.

More exciting still, those extra years would be healthy. What progress has been made in expanding lifespans has so far come by countering the causes of death, especially infectious disease. The process of ageing itself, with its attendant ills such as dementia, has not yet been slowed. This time, that is the intention.

The idea, as we set out in our Technology Quarterly, is to manipulate biological processes associated with ageing that, when dampened in laboratory animals, seem to extend their lives. Some of these are familiar, such as severely restricting the number of calories an animal consumes as part of an otherwise balanced diet. Living such a calorie-restricted life is too much to ask of most people; but drugs that affect the relevant biological pathways appear to bring similar results. One is metformin, which has been approved for use against type-2 diabetes; another is rapamycin, an immunosuppressant used in organ transplants. Early adopters are starting to take these drugs “off label”, off their own bat or by signing what amount to servicing contracts with a new class of longevity firms.

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Living to 120 is becoming an imaginable prospect. Excitingly, those extra years would be healthy—but there would be wide ramifications https://t.co/zuz1aKqGEN pic.twitter.com/kWzEk2QBrh

— The Economist (@TheEconomist) September 28, 2023

It was a phrase he repeated to himself several times each day when his patience started to wane and he could feel the frustration hardening in his chest: They were all doing their best. The police officers whose active patrol force had shrunk by 20 percent to crisis levels because of attrition, recruiting challenges and the impact of calls to defund the police. The people sleeping on sidewalks as rents soared to record highs and shelters filled to capacity. The addicts who could either wait in line at 6 a.m. for the outside chance of a spot in rehab or numb their pain with another fentanyl pill for the going price of 50 cents. They were all suffering together through the morass of a damaged society.

“Our entire first responder system in this city, according to the people who run it, is 20 years behind the ball and critically understaffed,” the mayor said last year at a City Council meeting. The city itself had increasingly turned to the same Band-Aid fix as everyone else, spending more than $4 million a year on private security guards to help protect parks, water treatment facilities, parking garages and city hall.

The booming industry was nobody’s idea of a perfect or comprehensive solution. More than a dozen security guards in Portland had been accused of assault or harassment, and one was convicted of murder earlier this year after fatally shooting a customer outside of a Lowe’s store. Guards in Oregon were sometimes trained and certified in as little as 16 hours, and more than 100 companies operated in downtown Portland on any given night under different policies and company rules.

Echelon was one of the most proactive, with more than 75 guards who patrolled the city 24 hours a day. At least 400 fed-up local businesses paid Echelon a monthly fee to run interference with homeless people by building relationships, offering resources to people with addictions and mental illness, buying their breakfasts, replacing their shoes, reversing their overdoses and de-escalating their episodes of psychosis.

Bock’s previous security job had been at a company that stationed him outside a grocery store as a deterrent to shoplifting and told him to avoid interacting with customers. “A human scarecrow,” was how Bock described that role, so he chose to move to Echelon in 2021 despite the long hours and middle-class pay, because he wanted to be part of the glue that pieced his hometown back together.

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"How can any of this be considered normal?" Another stunning @elisaslow story from the front lines of the urban unraveling, on one of the countless private security guards being hired to patrol American cities: https://t.co/kfYK1qGbNa

— Alec MacGillis (@AlecMacGillis) October 2, 2023

Almighty God,
you have made us for yourself,
and our hearts are restless till they find their rest in you:
pour your love into our hearts and draw us to yourself,
and so bring us at last to your heavenly city
where we shall see you face to face;
through Jesus Christ your Son our Lord,
who is alive and reigns with you,
in the unity of the Holy Spirit,
one God, now and for ever.
Amen.

Beautiful sunrise(looking more like Saturn) over the Charleston Harbor and the Old Village of Mount Pleasant this morning! pic.twitter.com/1U6WOad0fH

— Joey Sovine Live 5 (@JoeySovine) October 2, 2023

“Therefore I tell you, do not be anxious about your life, what you shall eat or what you shall drink, nor about your body, what you shall put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? And which of you by being anxious can add one cubit to his span of life? And why are you anxious about clothing? Consider the lilies of the field, how they grow; they neither toil nor spin; yet I tell you, even Solomon in all his glory was not arrayed like one of these. But if God so clothes the grass of the field, which today is alive and tomorrow is thrown into the oven, will he not much more clothe you, O men of little faith? Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the Gentiles seek all these things; and your heavenly Father knows that you need them all. But seek first his kingdom and his righteousness, and all these things shall be yours as well.

“Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Let the day’s own trouble be sufficient for the day.

–Matthew 6:25-34